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Mom lives with me for at least 30 years and Medicaid has always paid for her medical expenses, until now. I received two letters. The first letter is asking her to share cost of $724.00 for her adult health daycare where she attends daily. The second letter is notifying her that her medical benefits have been terminated as of June 1, 2019. I received it today. I have not mentioned it to her until this weekend.


The letter addresses her income of 1,300.00 a month. Apparently she makes too much money to qualify for benefits. However, for the past 30 plus years, she has not had any problems with Medicaid. The adult day care is new. She has been there for approximately 3 months.


I have requested a hearing and am awaiting a hearing date.


I don't know what else to do. I am here because I am lost in the system. If you need further clarification, please let me know.


I need help! Thank you so much for your input

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Thank you, everyone, for your kindness and thoughtfulness. I appreciate your input and feedback. I will post new information as it becomes available. God bless you all. Have a nice weekend.
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Update on mom's case:

I called Kaiser Permanente yesterday and they confirmed that she has coverage through Medicare. However, Medical/Medicaid discontinued her medical coverage.They told me call LA Care to get her reinstated. LA Care could not help me. They said to contact her case manager. Anyway, I am going in circles.

Before I called Kaiser, I visited the Welfare office and saw a case manager. She could not help me. I guess I need to wait for the hearing to see what will happen with her Medical issue.

So far, it feels like I am spinning my wheels and going nowhere.

Thank you for all who provided input and feedback.
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Thanks for the update! I hope you get some answers soon. Clearly something has changed and no one but Medi-cal got the memo! Like I said you are the second poster here to have this issue recently.
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Sorry-really long and boring but this is what they are basing her benefits on.
From cahealthadvocates.org;
“Aged & Disabled Federal Poverty Level (A&D FPL) Program;
If you are aged (65+) or disabled and are not eligible for the SSI program, you may be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level (A&D FPL) program. To qualify, you must:
Be aged (65+) or disabled (meet Social Security’s definition of disability, even if your disability is blindness).
Have less than $2,000 in assets for an individual ($3,000 for a couple). Like SSI, this program does not count all of your assets. For more information, see our Medi-Cal Programs – Qualification at a Glance chart (above).

!!!!This would be about your Mom!!!!!
***HAVE LESS THAN $1,271 in countable monthly income for an individual *** (She makes $1300./mo.)
($1,720 for a couple).
This Medi-Cal program uses SSI countable income rules as well as a few extra rules you should know. For more information, visit the Medi-Cal section of the Disability Benefits 101 website.”
———————
“Medi-Cal with a Share of Cost (SOC);
If your monthly income is higher than the limits to qualify for SSI or the A&D FPL program (see above), but you meet the asset-level requirements, you may still be eligible for Medi-Cal with a share of cost (SOC). An SOC functions like a deductible. You must pay this amount in any month you incur medical costs. After your SOC is paid, Medi-Cal will pay the remaining amount of your medical bills for that month.
Note: A SOC is not a monthly premium. It is more like a deductible. It is the amount of medical expenses you are responsible to pay for before you can get full Medi-Cal coverage for the remainder of the month. If you have no medical expenses, you pay nothing.
Your SOC is determined according to your monthly income, using the following formula: Medi-Cal subtracts $600 (for an individual) or $934 (for a couple) from your monthly income, and any other health-insurance premiums you may be paying.
For example, if you have an individual monthly income of $1,300, Medi-Cal subtracts $600 for a SOC of $700. This means you must pay at least $700 in covered medical expenses and/or health care premiums in a given month before Medi-Cal covers any of your health care costs for that month. For people with a high SOC, Medi-Cal is mostly a form of catastrophic coverage, meaning Medi-Cal will most likely only help them for emergencies or high-cost medical conditions.
Note: If you have Medi-Cal with a SOC, Medi-Cal will not pay your Medicare Part B monthly premium. This means your Part B premium will be deducted from your Social Security check each month. One exception applies if you are in a Medicare Savings Program (MSP)that pays for your Part B premium (QMB, SLMB or QI). If you are in one of these MSPs, you will not be affected.
If you meet your SOC with medical costs in any given month, Medi-Cal will retroactively pay your Part B premiums for the month(s) in which the SOC is met. Medi-Cal will send the payment to the Social Security Administration (SSA), which will refund you the amount of the premium. Any Part B premium refund received from the SSA will be counted as a resource, not income, in the month you receive it.”

She should still get Medicare (80% coverage hospital) with a deduction taken from her Social Security but no Medi-Cal (20% ) secondary. Hope this helps.
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Thank you, SueC1957, for this comprehensive information. I definitely appreciate your response and feedback. This website is so helpful. I am so blessed to be here. Many thanks.
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I believe the income limit for the Medi-cal benefit that covers adult daycare is around $1292. I think it is lower than the income limit for medical health insurance.

howoever since her benefits have now been cut off......what is the exact amount of her monthly income? She has to earn under $1436 a month in order to qualify for Medi-cal. So are you SURE her income is only $1300? It makes no sense that they dropped her if her income isn’t over $1436 a month. When it was time to re-certify, did all her documentation get turned in? I know at one time if you failed to turn in your income and all the required documents to re-certify, they would stop your benefits, don’t know if that’s still the case.
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Hello WorriedinCali,

Thank you for your response. Mom receive 1200 from Social Security and 150 from her pension, which amounts to 1,350.00 to be exact. When I visited the Medicaid office, I was told that she surpassed the requirement amount to continue her coverage. For this reason, she is asked to pay 724.00 for share cost. That is where we are until further notice. I submitted all paperwork and was received and processed.
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We live in California and my mother has Medicare, Kaiser Senior Advantage and Medi-Cal. Her only income is Social security and I pay her share of cost of $735 to the facility where she resides. He Kaiser Premium is 60 cents per month due to low income.

In my experience Kaiser has been my WORST NIGHTMARE and they are totally inept! I have dealt with our local Dept of Human Services (?) Office and they’ve always been polite and extremely helpful. I would contact them to see if your mothers benefits had been canceled and if so ask why. Then I would contact Kaiser (good luck with them, your going to need the patience of a saint) and tell them what the local office told you about your mothers benefits. If nothing has changed in the way of income etc, most likely Kaiser screwed up and it won’t be the first or last time they do this. Always write down the date, time, employee and Dept id of the person you speak to.

My mother had been on Medi-Cal for two years and I had notified Kaiser with a copy of her benefits letter to Kaiser several times in that two year period. She went to have a CT scan and the facility wanted $700 or they wouldn’t do the scan because Kaiser had never changed their records to show mom was on Medical-Cal. She had been transported to the office by medical transport so we had to have it done. It took over an hour arguing with Kaiser back and forth about her benefits and oh I’m sorry, one Dept had the info and one didn’t but they never put it in the system in that 2 yr period. I could go on but you get the idea. Good luck!
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Thank you, SMGB2017:

I called Kaiser this morning and they wanted mom to authorize before they can speak to me. She isn't here at the moment. So, I will call them when mom returns home. Will keep you updated. Thank you very much for your suggestions.
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Hi Godsbeautiful1,
Just to get the correct information;
Medicare is a government sponsored health plan for senior citizens in 50 states.
Medicaid is a government sponsored health plan for low or no income in 49 states.
Medi-Cal is a government sponsored health plan for low to no income California.

Please read this; https://cahealthadvocates.org/low-income-help/medi-cal-for-people-with-medicare/
It explains using Medicare with Medi-Cal.

I’m familiar with the Kaiser system. Have you called Member Services to ask about the situation?

Did your mother’s financial situation change recently ($ gifts, inheritance, etc.)? That can disqualify her.

Is your mother a U.S. citizen or legal permanent resident? If not, she may not qualify for benefits.

I’m assuming your mom is over 65, so she should qualify for Medicare (the 80% paid government medical health coverage for seniors). If she has less than $2000. in the bank AND makes $1400./mo. or less, she should qualify for Medi-Cal.

You mentioned “Medicaid” twice. Medicaid is the term used for 49 out of 50 states for low income people without health insurance. California has their own system called Medi-Cal. Did you just move to California?

Medicare (seniors gov. health insurance paying 80%) works also with Medi-Cal (California’s health insurance for the poor (covering the other 20%). Your Mom should have both of these.

If your mom has a social worker through either Medicare, Medicaid or Medi-Cal, you also need to speak with him/her. They can reinstate her insurance and pay for past medical bills (like anything you had to pay for this month without coverage).

It’s very odd that you received a cancellation of benefits 18 days AFTER the cutoff (June 1).

I can’t speak about the daycare payment because I have no experience in that area.

Best of luck navigating the system. I hope your mom gets reinstated.
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Hello SueC1957,

Thank you for your response. Mom is a citizen of the US. No gifts received. No new income.

I will follow up on your suggestions. You have provided some good resources and I can surely use them all.

Thank you very much. I will post updates. Have a nice day.
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How does she make too much now for Medicaid but didn't before? Also, does she have Medicare? She is going to have to have medical coverage. What state do you live in? Different states have different income limits.
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She has Medicare Part A and B. We live in California. Her coverage is through Kaiser Permanente Foundation. The letter is received came directly from them. I will call today to get clarification because it all seems too strange.

I visited the Medicaid office last week with regards to her $724 share cost. I was told that her income exceeded the $600.00 plus dollars. This is news to us, since she has had this income since her husband die 30 plus years ago.
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$1,300 sure doesn’t sound like “too much”. And I understand how you feel about being “lost in the system”. We were booted off food stamps when my husband”s SS went up by $25 and put us over the limit.

Unfortunately, you’ll just have to wait for the hearing. Stay on them. Save all your receipts and paperwork because they’ll ask for it. In an extreme situation, you can hire an attorney who’s experienced in handling Medicaid.
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Thank you, Ahmijoy. I will save all receipts. I appreciate your feedback and advice. Have a great day.
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